- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $60.26 / $213.80
| Facility | | $48.98 | $60.26 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $48.98 / $66.07 / $138.04
| Professional | | $48.98 | $66.07 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $52.48 / $77.62
| Facility | | $52.48 | $52.48 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $66.07 / $87.10 / $120.23
| Professional | | $66.07 | $87.10 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $74.13 / $74.13 / $104.71
| Professional | | $74.13 | $74.13 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $117.49 / $117.49 / $251.19
| Facility | | $117.49 | $117.49 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $44.67 / $67.61 / $114.82
| Professional | | $44.67 | $67.61 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $58.88 / $77.62 / $102.33
| Professional | | $58.88 | $77.62 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $141.25 / $141.25 / $141.25
| Professional | | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $64.57 / $75.86 / $114.82
| Facility | | $64.57 | $75.86 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $25.12 / $34.67 / $69.18
| Professional | | $25.12 | $34.67 | $69.18 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $61.66 / $85.11 / $141.25
| Facility | | $61.66 | $85.11 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $67.61 / $89.13 / $141.25
| Professional | | $67.61 | $89.13 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $52.48 / $56.23 / $1,096.48
| Facility | | $52.48 | $56.23 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $45.71 / $70.79 / $114.82
| Professional | | $45.71 | $70.79 | $114.82 |